Transplant Pregnancy Registry International

Coscia, Lisa A.; Daly, Theresa; Nathan, Howard M.; Armenti, Dawn; Kliniewski, Dorothy; Constantinescu, S; Moritz, Michael J.

doi:10.1097/01.tp.0000525078.35784.d3

Cited by 7 publications

(29 citation statements)

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“…Pregnancies after kidney transplant are often complicated by pregnancy‐induced HTN and preeclampsia 16,45 . These conditions alone can cause an increase in preterm delivery 43 .…”

Section: Pregnancy In Aya Sot—female Recipientsmentioning

confidence: 99%

“…The Transplant Pregnancy Registry International (TPRI) is a voluntary pregnancy registry that has continuously been collecting posttransplant pregnancy outcome data since 1991 until the present. TPRI is a cohort study and utilizes retrospective and prospective registry data from pregnancies delivered between 1967 and present day 16 . The TPRI and its associated studies are approved by the Advarra Institutional Review Board.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider

Coscia,

Kliniewski,

Constantinescu

et al. 2024

Pediatric Transplantation

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BackgroundHealthcare providers who care for adolescent and young adult transplant recipients should be aware of contraception counseling and potential for pregnancy in this at‐risk cohort.MethodsThis paper will review contraceptive options in general for transplant recipients. There will also be a review of common immunosuppressive medications and their risk profile regarding pregnancy after transplantation. Data from the Transplant Pregnancy Registry International were analyzed looking at recipients conceiving under the age of 21 and were compared to overall pregnancy outcomes.ResultsOverall pregnancy outcomes in recipients under the age of 21 are like the adult cohort.ConclusionIt is imperative to provide contraception counseling to the adolescent and young adult and inform their caregiver that pregnancy can happen if the recipient is sexually active. Pregnant adolescent and young adult transplant recipients should be followed by a multidisciplinary team to assure a positive outcome for the recipient, transplant, and neonate.

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“…Pregnancies after kidney transplant are often complicated by pregnancy‐induced HTN and preeclampsia 16,45 . These conditions alone can cause an increase in preterm delivery 43 .…”

Section: Pregnancy In Aya Sot—female Recipientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider

Coscia,

Kliniewski,

Constantinescu

et al. 2024

Pediatric Transplantation

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“…Although pregnancy after SOT is a realistic option, these pregnancies have a substantially increased risk for many adverse reproductive outcomes, such as pre‐eclampsia, gestational hypertension, renal graft impairment, preterm birth, lower birth weight and intrauterine growth restriction 31–35 . In addition, to prevent graft rejection, appropriate management of tacrolimus therapy during pregnancy is of utmost importance.…”

Section: Introductionmentioning

confidence: 99%

Modelling changes in the pharmacokinetics of tacrolimus during pregnancy after kidney transplantation: A retrospective cohort study

Schagen,

Ulu,

Francke

et al. 2023

Brit J Clinical Pharma

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AimPregnancy after kidney transplantation is realistic but immunosuppressants should be continued to prevent rejection. Tacrolimus is safe during pregnancy and is routinely dosed based on whole‐blood pre‐dose concentrations. However, maintaining these concentrations is complicated as physiological changes during pregnancy affect tacrolimus’ pharmacokinetics. The aim of this study was to describe tacrolimus’ pharmacokinetics throughout pregnancy and explain the changes by investigating covariates in a population pharmacokinetic model.MethodsData of pregnant women using a twice‐daily tacrolimus formulation following kidney transplantation were retrospectively collected from six months before conception, throughout gestation, and up to six months postpartum. Pharmacokinetic analysis was performed using non‐linear mixed effects modelling. Demographic, clinical and genetic parameters were evaluated as covariates. The final model was evaluated using goodness‐of‐fit plots, visual predictive checks and a bootstrap analysis.ResultsA total of 260 whole‐blood tacrolimus pre‐dose concentrations from 14 pregnant kidney transplant recipients were included. Clearance increased during pregnancy from 34.5 to 41.7 L/h, by 15%, 19%, and 21% in the first, second, and third trimester, respectively, compared to prior to pregnancy. This indicates a required increase in the tacrolimus dose by the same percentage to maintain the pre‐pregnancy concentration. Haematocrit and gestational age were negatively correlated with tacrolimus clearance (p<0.01), explaining 18% of inter‐individual and 85% of inter‐occasion variability in oral clearance.ConclusionTacrolimus clearance increases during pregnancy, resulting in decreased exposure to tacrolimus, which is explained by gestational age and haematocrit. To maintain pre‐pregnancy target whole‐blood tacrolimus pre‐dose concentrations during pregnancy, increasing the dose is required.

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“…Single center and voluntary registry data 6–10 suggest pregnancy after SOT is largely successful but is associated with maternal and fetal risks including pre‐eclampsia, intrauterine growth restriction and prematurity 6–10 . There is also the possibility of acute rejection or loss of allograft function, 6–10 although these risks can be mitigated with careful monitoring 11 …”

Section: Introductionmentioning

confidence: 99%

“…Many women desire children after transplantation and previous studies suggest that their rate of interest is similar to the general population 4 ; for many women the prospect of having children after transplant is an important priority 5 . Single center and voluntary registry data 6–10 suggest pregnancy after SOT is largely successful but is associated with maternal and fetal risks including pre‐eclampsia, intrauterine growth restriction and prematurity 6–10 . There is also the possibility of acute rejection or loss of allograft function, 6–10 although these risks can be mitigated with careful monitoring 11 …”

Section: Introductionmentioning

confidence: 99%

A survey of solid organ transplant recipient attitudes and concerns regarding contraception and pregnancy

McIntosh

Puerzer

et al. 2023

Clinical Transplantation

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Introduction: Many women who are solid organ transplant (SOT) recipients wish to have children after transplantation. Contraception is an important component of post-transplant planning and care, given the increased risk associated with posttransplant pregnancies. We sought to understand patient attitudes and concerns about post-transplant contraception and pregnancy.Methods: Following a comprehensive literature review, our team developed a survey that was administered to female SOT recipients of childbearing age. We used descriptive and inferential statistics to characterize participant views Results: A total of 243 transplant recipients completed the survey (80.7% response rate). The mean age of respondents was 37.5 years (±8.1 years), 66.7% were kidney recipients, and 40.7% were within the first year after transplant. The most common concerns among respondents included fetal and maternal health complications. Participants generally did not agree that transplant recipients should be advised to avoid pregnancy. There was strong support for shared decision-making about pregnancy after transplantation Conclusion: Understanding patient perspectives can help transplant providers make better care recommendations and support patient autonomy in reproductive decisions post-transplant. Given that there are some differences in views by transplant type, individualized conversations between patients and providers are needed.

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Transplant Pregnancy Registry International

Cited by 7 publications

References 0 publications

Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider

Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider

Modelling changes in the pharmacokinetics of tacrolimus during pregnancy after kidney transplantation: A retrospective cohort study

A survey of solid organ transplant recipient attitudes and concerns regarding contraception and pregnancy

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